Journal article
Pancreatoscopy guided lithotripsy for difficult pancreatic duct stones: Evidence and treatment selection in chronic pancreatitis
World journal of gastrointestinal endoscopy
07/20/2026
DOI: 10.4253/wjge.122451
Abstract
Difficult main pancreatic duct stones in chronic pancreatitis are challenging not only because they are hard to fragment, but because duct clearance does not necessarily translate into durable clinical benefit. Pain relief, freedom from repeated procedures, and avoidance of later surgery should therefore be considered separately from technicalclearance. Extracorporeal shock wave lithotripsy (ESWL), usually followed byendoscopic retrograde cholangiopancreatography (ERCP), remains a guideline-supported option for radiopaque stones measuring at least 5 mm in the pancreatic heador body, as well as for large, dense, multiple, or diffuse stone burdens. Digitalpancreatoscopy-guided electrohydraulic lithotripsy or laser lithotripsy offers a differentadvantage: Direct intraductal visualization, targeted fragmentation, and immediateassessment of residual fragments, strictures, and drainage. We reviewed English-language publications available through May 2026. Current data show high technicalsuccess in selected patients, and some observational studies suggest fewer treatmentsessions than with ESWL. However, randomized comparative data remain limited, andsham controlled and surgery comparison trials show that ductal clearance alone is anincomplete measure of patient benefit. The key question is therefore which patients aremost likely to benefit from pancreatoscopy-guided lithotripsy, how it should besequenced with ESWL and ERCP, how procedural risk and treatment burden should beweighed, and when surgery should be considered earlier. This mini-review presents apractical framework in which pancreatoscopy is used selectively, not as a replacementfor ESWL or only as a rescue technique.
Details
- Title: Subtitle
- Pancreatoscopy guided lithotripsy for difficult pancreatic duct stones: Evidence and treatment selection in chronic pancreatitis
- Creators
- Rintaro Hashimoto - University of Iowa
- Resource Type
- Journal article
- Publication Details
- World journal of gastrointestinal endoscopy
- DOI
- 10.4253/wjge.122451
- ISSN
- 1948-5190
- eISSN
- 1948-5190
- Language
- English
- Electronic publication date
- 07/20/2026
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985213548202771
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